Vasodilator Treatment for Mild to Moderate Heart Failure

Abstract

18 patients (14 men, 4 women) with a mean age of 64.3 years (range 41–75) and with chronic cardiac failure, NYHA functional class 1–2 (12 cases) or 2–3 (6 cases), insufficiently responsive to digitalis and diuretics, were treated for 4 weeks with Ro 12–4713, a minoxidil-like drug. The effects were assessed at rest and during maximal exercise, each patient was his own control. All patients completed the study. The treatment did not affect the body weight, the heart rate or the blood pressure, but it should be stressed that all patients were normotensive. The ejection fraction (by ^99mTc pertechnetate scintigraphy) increased from 42.0 ± 10.0 (resting x ± SD) to 48.9 ± 8.7%, and from 44.7 ± 10.1 to 57.9 ± 8.7% (end-exercise values), both changes being significant (p < 0.0001). The ejection rate increased in a similar manner. The resting stroke volume increased from 53.5 ± 13.6 to 60.2 ± 16.5 ml (p < 0.005), but the exercise stroke volume did not increase significantly. The cardiac output increased both at rest and during exercise, but the changes did not reach statistical significance. The end-diastolic volume decreased from 132.6 ± 126.9 ± 47.0 to 126.9 ± 42.3 ml (resting values), and from 151.5 ± 44.4 to 120.6 ± 36.6 ml (exercise), the changes being significant (p < 0.005). The physical work capacity increased, i.e. the duration of exercise increased from 7.8 ± 3.2 to 9.9 ± 1.9 min (p < 0.05) and the ‘quality of life’ (symptoms related to heart failure) improved (fewer symptoms) in 14/18 patients. Mild side effects (ankle edema, facial swelling, electrocardiographic repolarization changes) were detected in 6/18 patients, they were reversible.